Provider Demographics
NPI:1861970220
Name:SELTZER, JACOB A (ATC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:A
Last Name:SELTZER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39-23 DAURIA DR
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5143
Mailing Address - Country:US
Mailing Address - Phone:201-562-8863
Mailing Address - Fax:
Practice Address - Street 1:39-23 DAURIA DR
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5143
Practice Address - Country:US
Practice Address - Phone:201-562-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-29
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer